J Korean Ophthalmol Soc.  1975 Dec;16(4):367-370.

A Modified Berke Operation for Ptosis

• Kim SH
• Lee DJ

Abstract

The surgical correction of blepharoptosis is accomplished by operations utilizing the levator frontalis or superior rectus muscle. To obtain the best results in ptosis surgery, it is necessayr to select the appropriate operation for each case. When the levator action is relatively good, resection of the levator muscle is the operation of choice. The treatment of choice when the levator function is minimal or absent is suspending the ptotic upper lid from the brow. For this purpose sutures of cat gut, silk and gold chain or wire (gold, platinum, tantalum, stainless steel), or sling technique of Kangaroo tendon, silicone, fascia lata, skin, orbicularis muscle and sclera have been used. According to Berke, of the above, fascia lata is the best because it does not pull out of the tissues or become infected as often as do other materials. Allogeneic fascia lata seems to be a desirable material, but it is not readily available. The authors attached the ptotic upper lid to the brow by means of using the levator muscle. Instead of resecting the levator muscle as in the Berke ptosis operation through the skiu route, we did not resect the muscle but utilized it. In the course of Berke operation, after the levator muscle has been completely freed, it is divided into three equal parts by longitudinal severing with scissors. The levator muscle is sutured to the upper tarsal edge in correct position with 6-0 cat gut. Next, three stab skin incisions are made at the eyebrow, one near the center, one in the nasal third, one in the temporal third. Three tunnels are made under the skin from the eyebrow incisions to the lid incis:ons. A small forceps is passed through this tunnel and a tongue of the levator muscle drown up and sutured to the frontalis muscle. The other two tongues of the levator muscle are sutured in the same way. The skin incisions are closed with 6-0 black silk, then Frost suture and pressure dressing are applied. The advantages of this method are remarkable, that is, increment of the post operative motility of the upper lid and utilzation of living autogeheic levater muscle VS. heterotopic graft of fascia lata or other materials in all six cases of our report, good results were obtained and infections or complications did not occur.

MeSH Terms

Animals
Bandages
Blepharoptosis
Cats
Eyebrows
Fascia Lata
Macropodidae
Platinum
Sclera
Silicones
Silk
Skin
Surgical Instruments
Sutures
Tantalum
Tendons
Tongue
Transplants
Platinum
Silicones
Silk
Tantalum